Workplace-based assessments of entrustable professional activities in a psychiatry core clerkship: an observational study

BackgroundEntrustable professional activities (EPAs) in competency-based, undergraduate medical education (UME) have led to new formative workplace-based assessments (WBA) using entrustment-supervision scales in clerkships. We conducted an observational, prospective cohort study to explore the usefulness of a WBA designed to assess core EPAs in a psychiatry clerkship.MethodsWe analyzed changes in self-entrustment ratings of students and the supervisors' ratings per EPA. Timing and frequencies of learner-initiated WBAs based on a prospective entrustment-supervision scale and resultant narrative feedback were analyzed quantitatively and qualitatively. Predictors for indirect supervision levels were explored via regression analysis, and narrative feedback was coded using thematic content analysis. Students evaluated the WBA after each clerkship rotation.ResultsEPA 1 (Take a patient's history), EPA 2 (Assess physical & mental status) and EPA 8 (Document & present a clinical encounter) were most frequently used for learner-initiated WBAs throughout the clerkship rotations in a sample of 83 students. Clinical residents signed off on the majority of the WBAs (71%). EPAs 1, 2, and 8 showed the largest increases in self-entrustment and received most of the indirect supervision level ratings. We found a moderate, positive correlation between self-entrusted supervision levels at the end of the clerkship and the number of documented entrustment-supervision ratings per EPA (p<0.0001). The number of entrustment ratings explained 6.5% of the variance in the supervisors' ratings for EPA 1. Narrative feedback was documented for 79% (n=214) of the WBAs. Most narratives addressed the Medical Expert role (77%, n=208) and used reinforcement (59%, n=161) as a feedback strategy. Students perceived the feedback as beneficial.ConclusionsUsing formative WBAs with an entrustment-supervision scale and prompts for written feedback facilitated targeted, high-quality feedback and effectively supported students' development toward self-entrusted, indirect supervision levels.

Automated summary

This study explored the usefulness of formative WBAs designed to assess core EPAs in a psychiatry clerkship, showing increases in self-entrustment levels and indirect supervision ratings for students. Most learner-initiated WBAs were signed off by clinical residents, and narrative feedback focused on the Medical Expert role, using reinforcement as a feedback strategy. Students perceived the feedback as beneficial for their development towards self-entrusted, indirect supervision levels.